Healthcare Provider Details

I. General information

NPI: 1275446809
Provider Name (Legal Business Name): SUSAN ELISE MILLER-JOSSELYN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 NE HALSEY ST STE 300
PORTLAND OR
97213-4759
US

IV. Provider business mailing address

6518 SE 50TH AVE
PORTLAND OR
97206-7626
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL11181
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: